Sawinski Deirdre, Murphy Barbara
Department of Medicine, Division of Nephrology, Mount Sinai School of Medicine, New York, NY 10029, USA.
Semin Nephrol. 2008 Nov;28(6):581-4. doi: 10.1016/j.semnephrol.2008.08.002.
Chronic kidney and end-stage renal disease are important complications of HIV disease and treatment. African Americans with HIV infection are at significantly increased risk for development of chronic kidney disease and for progression to end-stage renal disease. Survival of HIV-positive patients on dialysis has improved dramatically since the introduction of combination antiretroviral therapy, with hemodialysis and peritoneal dialysis appearing to offer similar survival. Renal transplant has been shown to be successful in HIV-positive patients and emerging data suggest a survival benefit over remaining on dialysis, despite data indicating an increased incidence of acute rejection. Immunosuppression dosing is complicated by interactions with antiretroviral therapy, and drug levels must be followed closely. Experience to date suggests that HIV-positive transplant recipients are best cared for in academic institutions with multi-disciplinary teams devoted to their care.
慢性肾脏病和终末期肾病是艾滋病病毒疾病及其治疗的重要并发症。感染艾滋病病毒的非裔美国人患慢性肾脏病以及进展至终末期肾病的风险显著增加。自联合抗逆转录病毒疗法引入以来，接受透析的艾滋病病毒阳性患者的生存率有了显著提高，血液透析和腹膜透析的生存率似乎相近。肾移植已被证明在艾滋病病毒阳性患者中是成功的，新出现的数据表明，与继续接受透析相比，肾移植对生存有益，尽管有数据显示急性排斥反应的发生率有所增加。免疫抑制药物的剂量因与抗逆转录病毒疗法的相互作用而变得复杂，必须密切监测药物水平。迄今为止的经验表明，艾滋病病毒阳性的移植受者在有专门多学科团队进行护理的学术机构中得到的护理最为理想。
